PHM-Exch> [PHM] a bit of history (5)

[Claudio Schuftan]

*CAPE TOWN CALL TO ACTION*

*2012 *



*A. Preamble *





After two years of participatory engagement and planning we, the People’s
Health Movement, have gathered 800 strong from 90 countries representing
the voices of tens of thousands more in our movement across every continent
in the world.



In Cape Town we have:



·       strengthened and deepened our resolve and solidarity

·       expressed our outrage at the continuing global health crises
embedded in a myriad of structural and socio-political inequities;

·       developed principles for an alternative economic, political and
social order[s]; and

·       re-committed ourselves to work towards the world we have
envisioned.





We reaffirm our commitment to the People’s Charter for Health and to the
Cuenca Declaration which are the foundational documents to this Call to
Action.



This Call to Action will guide our work until the Fourth People’s Health
Assembly.



*B. The Global Health Crisis *





Health in the world has been devastated by neoliberal policies that are the
hallmark of present day capitalism, and increasingly so by the global
crisis of capitalism. The current crisis underpins the growing global
health inequalities within and between countries.



*The health crisis comes with growing health inequalities *



The global health crisis is a consequence of the failure to address the
social, political and environmental determination of health, resulting in
an erosion of food sovereignty, in higher levels of poverty, as wellas in a
lack of fair and equitable access to water, housing, sanitation, education,
employment and universal and comprehensive health services.



 Ill-health and disability are being perpetuated by the aggressive
marketing of unhealthy products such as tobacco, alcohol, junk food and
beverages; by the pollution of our air, our land and water sources; by the
colonization of lands and other natural resources ; and by the forced
eviction of vast numbers of people [the population], including indigenous
peoples, from their lands and homes.



We have witnessed how:



·       small farmers are losing their livelihoods as a result of the
dumping of subsidised foodstuffs from the agriculture of industrialised in
countries in the North;

·       indigenous people are being herded off their land by the extractive
mining industry and the struggles by communities that are affected are
being criminalized;

·       the health of workers is jeopardised by the absence of safety [and]
regulations at the workplace, as well as by environmental degradation and
pollution;

·       poor people in dense urban settings are being driven to depend on
junk food, available more cheaply than nutritious natural food;

·       the relegation of women's health to only encompass maternity and
family planning, on the one hand, and the concerted attack on women's
reproductive and sexual rights, on the other, violates women's autonomy,
personhood, dignity and human rights;

·       women and young people are being denied the right to sexual and
reproductive health services;

·       migrants and displaced people suffer from xenophobia and from a
lack of access to healthcare; and

·       racism - social, institutional and structural - coupled with
religious intolerance, disrupts the lives of people and prevents them from
living a dignified life free of fear;

·       children’s rights are being undermined by denying them the
conditions in which they can thrive and flourish.



Millions of families, particularly in low- and middle-income countries, are
being denied access to comprehensive primary health care and universal
health services by way of their poverty and the other many institutional
barriers they face. In high income countries, there has been a continuing
campaign to reduce funding and support for the public sector and to replace
public services with those provided by the market. Moving health care out
of the public domain makes it easier for large capitalist enterprises (big
pharma, big insurance and biotechnology corporations) to increase sales and
profits, working in close partnership with those who profitfrom the
delivery of health services. The commodification of health has been
intensified by the persitence and thriving of the  reductionistic,
industrial, biomedical model.



The current global trade and investment regime (driven by multilateral,
plurilateraland bilateral trade and investments agreements) is seriously
undermining universal social entitlements and rights, as well as the
power[s] of states to regulate the activities’ of corporations and of
private financial institutions.



Access to affordable medicines has been compromised worldwide as a result
of the WTO-TRIPS Agreement and the continuing pressure on developing
countries to adopt TRIPS-plus standards through trade agreements and bogus
anti-counterfeiting initiatives.



While we welcome the recent [up]surge in interest in the concept of
universal health coverage, we oppose the idea that this be achieved through
the promotion of a minimalistic insurance model that would offer 'basic
packages of care' and would operate within a market-based system of
healthcare. We oppose attempts to use this approach to dismantle or
undermine the public health system to promote corporate interests in health
care delivery. Universal health coverage must be achieved through organized
and accountable systems of high quality public provision of comprehensive
primary health care and of a working referral system governed by need of
care.



The global health crisis also reflects a crisis in effective and
accountable global health governance. The dimensions of this crisis
include:



·       The undermining of the World Health Organisation

·       The power exerted by a fragmented and uncoordinated health aid
industry

·       The undue influence of unaccountable private corporations and
foundations over health policy and programming

·       An approach that seeks to remedy the problems of structural
inequality through a ‘charity’ model rather than through systemic and
structural transformations.



*The crises of capitalism *



*Genesis of the current crisis*

The current capitalist crisis has several inter-related dimensions, among
them: political, food, economic, financial and ecological dimensions. Its
roots lie in the neoliberal model of globalisation that emerged in the
1970s as a response to declining rates of profit and wealth accumulation in
developed capitalist economies. It also included privatisation and
commercialisation of public services, such as in health, education, water
and energy supply and public transport. The model, in its endeavour to
create a global market for goods and services, promotes the integration of
global economies and the expansion and liberalization of global trade.



This model was and is forced upon developing countries through structural
adjustment programmes, trade agreements and investment treaties,
effectively legally locking many developing countries into the neoliberal
paradigm which is highly inequitable and, at best, extremely inefficient in
reducing poverty and meeting people’s livelihood needs.



Meanwhile, the current development and aid industry merely sustains and
reproduces existing social and political inequalities.



Neoliberal globalisation has resulted in an immense concentration of power
among a wealthy and corporate elite who actively undermine democracy and
social justice through their influence and through the corruption of
national governments and international institutions. The present political
crisis is rooted in the lack of accountable, transparent and democratic
decision-making. Even in countries with progressive governments, spaces for
democratic participation are closing [down] and protest is being
criminalized.



The war industry, having blighted lives in many parts of the world, is
deeply embedded within the capitalist economic system. Imperialism has
increased the use of its military might to maintain and expand its control
over the political architecture, as well as the resources of the planet.



There is a need to redesign our political culture and our institutions,
both nationally and globally; to create relations based on solidarity; and
to put in place the mechanisms of accountability needed to run the global
political, economic and social structures in a manner that is just,
equitable and sustainable.



*The crisis today and its manifestations*

The current financial crisis is rooted in the de-regulation of banks that
were allowed to become ‘too big to fail', to increase their ratio of loans
(debts) to assets, and to speculate heavily on currencies, on derivatives
and on mortgages.



The response of national and international institutions has been merely to
‘restore the confidence’ of the same institutions and financial markets
that caused the crisis in the first place. Governments have moved quickly
to bail out the failing banks and have enacted a host of ‘austerity
agendas’ the world over effectively cutting health and social spending thus
deepening and reinforcing the very neoliberal economic model the crisis has
so discredited, and handing even more power to the managers of finance
capital.



The ecological crisis is also a part of the capitalist crisis and mirrors
the rise in global inequalities as characterized by the obscene
over-consumption of a small minority that is overstretching the capacity of
the planet[,] while a large majority are denied even their basic needs. The
resources of this planet are being privatized and plundered in ways that
are damaging and lethal for future generations. Public stewardship of our
scarce resources is the only solution to the equitable protection of the
planet.



Rich nations are passing on the burden of the ecological crisis onto poor
nations through various mechanisms, including through the shifting of
negative externalities onto poor peoples. Coercive population control
policies enacted in the name of climate protection are now violating
women’s rights. Many of the effects of overproduction and overconsumption
and of climate change are felt by the world's indigenous communities,
small-scale peasant farmers, poor people and the working classes.  Although
the planet is capable of providing for the needs of all its people, the
current system of production and consumption only undermines the natural
basis of life through a need for constant growth[, while] leaving billions
of people in poverty.



The annual Conference of the Parties (COP) meeting under the UN Convention
on Climate Change has failed miserably to ensure the rapid reduction in the
emissions of greenhouse gases. Under the domination of predatory
transnational corporations the negotiations have sought to impose false
solutions such as carbon trading, Reducing Emissions from Deforestation and
Forest Degradation (REDD) and other market/financial incentives to safeguard
continued profit margins and the continuity of economic growth.



The food crisis as evidenced by the existence of a billion hungry people
and two billion overweight or obese people is a manifestation of a much
larger and more pervasive malaise caused by the loss of food sovereignty
and of control by communities and poor nations over the use of their own
resources. The food system is dominated by transnational corporations (big
agribusiness and big food and beverage corporations). This has resulted in,
among other things, mono-cropping and the replacement of food crops with
crops for bio-fuels; a huge increase in the speculative trading of food
grains; unfair trade agreements; and oligopolies in the food retail sector.
The food crisis is now deepening by ‘land grabs’, a new form of colonialism
in which transnational corporations and sovereign wealth funds are
acquiring large tracts of arable land in poor and often poorly governed
countries – displacing domestic food production systems, as well as rural
peoples from their lands. Meanwhile, hunger and malnutrition is being
converted into a new market for processed ready-to-use foods (RUTF) and
nutriceuticals, often assisted by the aid industry and multilateral
organisations.



*C. Our Alternative
Vision
                           *





PHM seeks a better world and offers a critical alternative. We believe that
transformative and radical change is needed and can indeed be achieved. Our
vision consists of a number of inter-related dimensions:



·       A reformed economic system

·       Just, fair and democratic political and economic processes and
institutions

·       A better global heath governance

·       Equitable [and] Public Health Systems.



*Reformed economic system*

We need an economic system that values every individual, not every dollar.
The primary objective must be to maximise benefits to people – their
health, their wellbeing, and their quality of life – not total output or
income. It should be based on collaboration[,] within and between
communities and nations, not on competition, and should seek to minimise
the use of environmental resources and capacity? while fostering
sustainable livelihoods for all. It will  be socially directed rather than
market driven.



Such an economic system will:



·       encourage adequate, appropriate, equitable and sustainable
consumption, with the least ecological and human impact, reflecting a
commitment to future generations and harmony with the planet.

·       replace existing global and regional trade and financial agreements
with those that will eradicate food insecurity and malnutrition and will
foster food sovereignty;

·       be rooted in and have obligations towards local communities while
being globally responsible;

·       establish and develop worker controlled enterprises;

·       create sustainable, dignified work opportunities that meet the
basic needs of all,

·       build solidarity links between people;

·       reverse the land grabs that are ongoing; and

·       be rooted in the effective measurement of societal progress on the
basis of health, social and environmental indicators.



*Just. fair and democratic political and economic processes and
institutions *

We need a new system of global governance, including governance in the
different international trade and financial systems, that :

·       places health, well-being, human rights and environmental
sustainability at the centre of all policies,

·       ensures genuine equality of influence at the heart of all
decision-making,

·       promotes democracy, accountability and transparency at all levels.



We need news systems of national governance:

·       in which electoral democracy is not captured by capital or undue
private interests influence;

·       where forms of participatory democracy are integral to structures
of governance;

·       where people have adequate constitutional rights and protections,
including the right to protest against conditions or practices that create
social exclusion and oppression.



We seek a world in which governments will:



·       work multi-laterally to reach peaceful resolutions to international
conflicts

·       refrain from imposition of their own policies and interests on
other sovereign nations, whether through force or by economic pressures;

·       be held accountable for the full implementation of the Universal
Declaration of Human Rights and the Covenants on Political, Civll and
Economic, Social and Cultural Rights.



A new system of global and national governance will include regulatory
structures that, among other, ensure:



·       fair and progressive taxation regimes within and between countries
that will enable a transformative and equitable redistribution of resources
and power;

·       closure of tax havens and democratic reform and regulation of the
international banking system;

·       fair trade arrangements and agreements;

·       a new regime for research and development that does not seek to
monopolise knowledge in a few hands, prioritises the genuine needs of the
largest numbers of people and sees local communities as equal partners
in  applied
research endeavours.

·       a new regime for the production, management and distribution of
knowledge and technology that prevents their private appropriation and
promotes an open system of knowledge sharing.



*A better global heath governance*

We seek a more coherent and accountable system of global health governance
that is free from corporate influence and the influence of unaccountable
private actors. We seek a radical rationalization of the multiple Global
Health Partnerships and funds. We seek new and more accountable mechanisms
for the management and allocation of global public finance, working with
and through UN institutions.



The World Health Organisation must:

·       follow its constitutional mandate to act as the directing and
coordinating authority for international and global health

·       be fully and adequately funded by assessed and untied contributions
from sovereign nations/member States

·       be de-facto accountable to countries/States? and the people of the
world



*Equitable [and] Public Health Systems *

Health systems must progressively become:

·       Universal, integrated and comprehensive, as well as provide a
platform for appropriate action as regards the social determinantion of
health;

·       supported by a guarantee of the right to health in the national
constitution;

·       based on accessible, effective, gender-sensitive, youth-friendly
and free comprehensive primary health care, accountable and appropriate to
people’s health needs;       accessible to all, with no discrimination on
the basis of gender, age, race, ethnicity, religion, economic status,
sexual identity, disability, cultural knowledge, language or any other
basis;

·       welcoming of alternate cultural understandings of health and
systems of healing, and not based solely on biomedical concepts of health
and illness;

·       properly and adequately publicly financed with public expenditure
representing the major share of total health expenditures, as well as
capable of protecting the population against the rising costs of health
care;

·       be [cap]able to retain local health workers within the national
health system rather than losing them to international migration;

·       built around an integrated network of public facilities responsible
for providing comprehensive care, based on the principles of universality
and equality;

·      able to strictly regulate commercial health care providers (where
present) within an ethical framework;

·       participatory and responsive to peoples’ needs through social
participation in the formulation, implementation, monitoring and evaluation
of policies;

·       compatible with sound ecological principles and practices.



PHM will also work towards developing frameworks of analysis using its
global community of public health practitioners, academicians and activists
who can work on innovative and creative design solutions that will ensure
more effective, efficient and equitable public health systems.





*D. What is to be Done? *





This Call to Action was developed at and is directed to all delegates of
the Third Peoples Health Assembly (Cape Town July 2012) and their fellow
health and social activists from across the world.



*D.1. Power to the People: Building the Movement *



No change will happen without the mobilization of people. Power is not
given to the people; it has to be exacted from the political, corporate and
financial elites; Our members will hold [our] public institutions
accountable and will make them work in ways that are transparent and truly
representative and that serve the public interest and social justice. All
this requires the building of social and political power among[st] people
and communities.



The Third PHA celebrated the successes of the growing People’s Health
Movement, especially the development of new country circles in Africa.
While we are a movement focused on health and are built mainly around
health activism, we share many goals with other social movements that also
seek a more just and sustainable world. In order to diminish the power of
financial capital, democratize governance and defeat neoliberal economic
policies, we simply need to build a more effective and broad-based social
movement.



To this end, we commit ourselves to building alliances with others who seek
progressive and transformative change. PHM is in a unique position to build
alliances across existing movements, including those of informal and formal
sector workers, the landless, indigenous peoples, women and youth.



We will build solidarity with those struggling against big dams, nuclear
power plants, illegal mining, hazardous working conditions and others. We
will work with the environmental justice movement. We will seek [to
encourage] greater trans-disciplinary engagement with, among others,
progressive economists, environmental scientists, lawyers, urban planners
and political-social scientists.



We leave/ left Cape Town determined to:

·       set up new PHM circles

·       energise, broaden and deepen the work of existing PHM country
circles

·       strengthen and develop the issue-based (thematic) circles of the
PHM.



We leave/ left Cape Town with a new and reinvigorated and rejuvenated
Global Steering Council that, among other, will improve communications
within the movement, facilitate effective coordination across the movement
and ensure organic linkages with regional and country circles. This will
include facilitating the recruitment and support of PHM outreach workers to
assist the development of [the] PHM in countries and regions.



We will strive to foster and develop community-based struggles, campaigns
and advocacy initiatives from local to national and global levels on
multiple fronts,  as well as develop the health movement in the coming
phase.



*D.2. Creating and communicating alternative visions, analyses, discourses
based on the evidence presented above *



We recognise that the neoliberal orthodoxy and the vested interests of the
rich and powerful are heavily represented in the mainstream media. We
recognise the power of the mainstream media and of corporate propaganda in
shaping prevailing views and attitudes and sustaining the belief that there
is no alternative to the current political and economic system.



We recognize that many scientific journals and institutions of education
and knowledge generation act to legitimize and sustain the current system
and paradigm. We recognise the lack of investment in research, in
monitoring and surveillance that will serve the interests of the poor and
promote the global social justice and equity agenda PHM stands for.



To this end we leave/left Cape Town and commit/ed to:



·       communicating the alternative vision[s] advanced in this CTA,
together with its analyses and discourses to the people, using a wide
variety of media and communication techniques, especially those that engage
people creatively;

·       using the Global Health Watch as an instrument to communicate our
alternative progressive analysis of the state of global health and our
critiques of the current institutional framework for global health. We will
work to improve the dissemination of the [contents of] periodic GHWs both
in English and in other languages using alternative media so as to reach a
greater diversity of audiences. We will [create and] establish and maintain
local and national health watches;

·       expanding and extending the reach of the International Peoples
Health University (IPHU) as a means of education, empowerment and
mobilisation of young PHM cadres;

·       expanding processes such as community-based monitoring to ensure
health system accountability and community oriented action research.



*D.3. Organising and planning to make change happen *



To make change happen, movement building and alternative analyses must be
translated into concrete campaigns and programmes of action.  Actions will
need to be planned and organised at the local and national levels. However,
as a global movement, we will seek to actively support and facilitate a
range of campaigns, by:



·       providing information and facilitating the sharing of information
on the international context that affects country experiences;

·       providing campaigning materials on issues of international
priority;

·       liaising and coordinating with organisations in different countries
working on related issues;

·       providing multiple fora for the sharing of experiences;

·       supporting campaigns at the international level giving e wide
publicity;

·       [facilitating advocacy regarding] actively mobilizing to oppose
health damaging policies and actions of international organizations and of
Northern governments.



To enable us to fulfil this role effectively, we will intensify our
fundraising efforts, in order to strengthen the movement through:

   - Increasing the capacity of young PHM activists through supporting more
   IPHUs;
   - strengthening regions and countries through the recruitment of
   regional outreach coordinators;
   - Increasing regional support to build the movement at the local and
   country level;
   - Strengthening the global secretariat;
   - Increasing the resources available for information, media and advocacy
   activities at the international and local levels.



We will continue and expand our global work around existing global
programmes – suitably redesigned wherever necessary, namely:

·       the Right to health campaign

·       the International Peoples Health University

·       the Global Health Watch

·       the Democratising Global Health; WHO Watch and Supporting the
Restitution of the WHO
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